title: The association between cannabis use and depression: a systematic review and meta-analysis of longitudinal studies.
abstract: BACKGROUND
  Longitudinal studies reporting the association between cannabis use and developing depression provide mixed results. The objective of this study was to establish the extent to which different patterns of use of cannabis are associated with the development of depression using meta-analysis of longitudinal studies.
  
  
  METHODS
  Peer-reviewed publications reporting the risk of developing depression in cannabis users were located using searches of EMBASE, Medline, PsychINFO and ISI Web of Science. Only longitudinal studies that controlled for depression at baseline were included. Data on several study characteristics, including measures of cannabis use, measures of depression and control variables, were extracted. Odds ratios (ORs) were extracted by age and length of follow-up.
  
  
  RESULTS
  After screening for 4764 articles, 57 articles were selected for full-text review, of which 14 were included in the quantitative analysis (total number of subjects = 76058). The OR for cannabis users developing depression compared with controls was 1.17 [95% confidence interval (CI) 1.05-1.30]. The OR for heavy cannabis users developing depression was 1.62 (95% CI 1.21-2.16), compared with non-users or light users. Meta-regression revealed no significant differences in effect based on age of subjects and marginal difference in effect based on length of follow-up in the individual studies. There was large heterogeneity in the number and type of control variables in the different studies.
  
  
  CONCLUSIONS
  Cannabis use, and particularly heavy cannabis use, may be associated with an increased risk for developing depressive disorders. There is need for further longitudinal exploration of the association between cannabis use and developing depression, particularly taking into account cumulative exposure to cannabis and potentially significant confounding factors.
authors.affiliation: Social Aetiology of Mental Illness (SAMI) CIHR Training Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
authors.forename: S
authors.initials: S
authors.lastname: Lev-Ran
authors.affiliation: Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
authors.forename: M
authors.initials: M
authors.lastname: Roerecke
authors.affiliation: Addictions Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
authors.forename: B
authors.initials: B
authors.lastname: Le Foll
authors.affiliation: Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada.
authors.forename: T P
authors.initials: TP
authors.lastname: George
authors.affiliation: Social Aetiology of Mental Illness (SAMI) CIHR Training Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
authors.forename: K
authors.initials: K
authors.lastname: McKenzie
authors.affiliation: Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada.
authors.forename: J
authors.initials: J
authors.lastname: Rehm
mesh_terms: D003866:Depressive Disorder / Q000139:chemically induced / Q000453:epidemiology* / Q000209:etiology; D006801:Humans; D002189:Marijuana Abuse / Q000150:complications / Q000453:epidemiology*